Free ACT questionnaire may be superior to $3,000 FeNO device in determining asthma control in children

This study from Turkey included 76 children 6 to 11 years of age (mean age 8.7) with asthma who completed Childhood Asthma Control Test (C-ACT) and underwent fractional concentration of exhaled nitric oxide (FeNO) and spirometric measurements during the monthly clinic visits.

A C-ACT score of 22 or less had 69% sensitivity and 77% specificity in determining not well-controlled asthma, whereas an FeNO value of 19 ppb or higher had 61% sensitivity and 59% specificity. Receiver operating characteristic curve analysis revealed that the C-ACT was better than FeNO for identifying patients with uncontrolled asthma.

A C-ACT score of 22 or less (odds ratio, 8.75) and an FeNO of 19 ppb or greater (odds ratio, 2.60) were indicators for uncontrolled asthma.

The authors concluded that C-ACT is superior to FeNO in determining the control status of children with asthma.

Editor’s note: Measurement of fractional concentration of exhaled nitric oxide (FeNO) has its place in the care of adults and children and is incorporated in the asthma guidelines ( However, considering the cost of the device (for example, Niox Mino is priced above $3,000 in the U.S.), the use of a simple paper- or computer-based C-ACT score test has obvious cost-saving advantages. It is encouraging to have the scientific evidence that supports that this cost-saving approach can also be more accurate in children with asthma.


Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement. Yavuz ST, Civelek E, Sahiner UM, Buyuktiryaki AB, Tuncer A, Karabulut E, Sekerel BE. Ann Allergy Asthma Immunol. 2012 Jul;109(1):36-40. Epub 2012 May 31.

Childhood Asthma Control Test - by GSK

The Childhood Asthma Control Test∗: Retrospective determination and clinical validation of a cut point to identify children with very poorly controlled asthma. JACI, 2010

Comments from Twitter:

Dr John Weiner @AllergyNet: Reassuring. Many of us use ACT

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